MEDICARE: IOWA VEIN CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CS6841	OTHER	IA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	22927	OTHER	IA	WELLMARK

General Provider Information

NPI Number	:	1649394842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IOWA VEIN CENTER, INC.

Provider Business Mailing Address
First Line	:	2425 WESTOWN PKWY
Second Line	:	SUITE 100
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1425
Country	:	US
Telephone Number	:	515-222-8346
Fax Number	:	515-222-0472

Provider Business Practice Location Address
First Line	:	2425 WESTOWN PKWY
Second Line	:	SUITE 100
City	:	WEST DES MOINES
State	:	IA
Zip	:	50266-1425
Country	:	US
Telephone Number	:	515-222-8346
Fax Number	:	515-222-0472

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. JOSE A. OLIVENCIA
Credential	:	M.D.
Telephone Number	:	515-222-8346

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/22/2020

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Directions to “IOWA VEIN CENTER, INC. ” Practice Location

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